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Neck dissection

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Neck dissection

  1. 1. Neck dissectionDr. Mansoor Khan Resident Plastic Surgery<br />
  2. 2. Introduction<br />Status of the cervical lymph nodes<br />important prognostic factor in the head and neck tumors<br />
  3. 3. Introduction<br />Cure rates drop into half when there is regional lymph node involvement<br />
  4. 4. Emil Theodor Kocher<br />Earned Nobel Prize in 1909 for his work in thyroid and neck <br />surgery — the first ever awarded to a surgeon.<br />1880 – Kocher proposed removing nodal<br />metastases<br />
  5. 5. 1906 – George Crile<br />described the classic radical neck dissection (RND)<br />
  6. 6. 1967 - Bocca and Pignataro<br />described the “functional neck dissection” (FND)<br />
  7. 7.
  8. 8. Level - I<br />
  9. 9. Level - II<br />
  10. 10. Level - III<br />
  11. 11. Level - IV<br />
  12. 12. Level - V<br />
  13. 13. Level - VI<br />
  14. 14. Subzones of Levels I-V<br />
  15. 15. Level IA<br />Floor of mouth, anterior oral tongue, anterior mandibularalveolar ridge, lower lip<br />Level IB<br />Oral cavity, anterior nasal cavity, soft<br />tissue of midface, submandibular gland<br />
  16. 16. Level IIA & IIB<br />Oral cavity, nasal cavity, nasopharynx, oropharynx,, hypopharynx, larynx, parotid gland<br />
  17. 17. Level III<br />Oral cavity, nasopharynx, oropharynx, hypopharynx, larynx<br />
  18. 18. Level IV<br />Hypopharynx, thyroid, cervical esophagus, larynx<br />
  19. 19. Level VA & VB<br />Nasopharynx, oropharynx, posterior scalp/neck skin<br />
  20. 20. Level VI<br />Thyroid gland, glottic and subglotticlarynx, apex of piriform sinus, cervical esophagus<br />
  21. 21. “N” classification – AJCC (1997)<br />Consistent for all mucosal sites except the nasopharynx<br />Staging of the neck<br />Thyroid and nasopharynx <br />have different staging based on tumor behavior and prognosis<br />
  22. 22. Single ipsilateral lymph node 3 to 6 cm<br />Single ipsilateral lymph node, < 3 cm<br />No regional lymph node metastases<br />Multiple ipsilateral lymph nodes < 6 cm<br />Bilateral or contralateral nodes < 6cm<br />Metastases > 6 cm<br />Lymph node staging<br />
  23. 23. Classification<br />
  24. 24. Extent of Radical Neck Dissection <br />Radical Neck Dissection <br />All lymph nodes in Levels I-V including spinal accessory nerve (SAN), SCM, and IJV<br />
  25. 25. Modified Radical Neck<br />Excision of same lymph node bearing regions as RND with preservation of one or more nonlymphatic structures (SAN, SCM, IJV)<br />
  26. 26. MRND Type I<br />Preservation of SAN<br />
  27. 27. MRND Type II<br />Preservation of SAN and IJV<br />
  28. 28. MRND Type III<br />Preservation of SAN, IJV, and SCM <br />( “Functional neck dissection”)<br />
  29. 29. Supraomohyoid neck dissection<br />Selective Neck Dissections<br />
  30. 30. Selective Neck Dissections<br />Lateral neck dissection<br />
  31. 31. Extended Neck Dissection<br />Any dissection which includes<br />removal of one or more additional lymph node groups and/or non-lymphatic structures.<br />
  32. 32. Algorithm for treating an N0 <br />
  33. 33. T3 or T4 Oral cavity tumors and tumor thickness (>3 mm) supraomohyoidneck dissection.<br />Increasing stage of the oropharynx, hypopharynx, and supraglottic larynx needs lateral neck dissection.<br />Algorithm for treating an N0 <br />
  34. 34. N+ disease needs Comprehensive neck dissection<br />
  35. 35. “Surgical approach”Incisions<br />
  36. 36. A p r o n I n c i s i o n<br />
  37. 37. H a l f A p r o n I n c i s i o n<br />
  38. 38. C o n l e y I n c i s i o n<br />
  39. 39. Y - I n c i s i o n<br />
  40. 40. D o u b l e – Y I n c i s i o n<br />
  41. 41. H -I n c i s i o n<br />
  42. 42. M a c F e e I n c i s i o n<br />
  43. 43. S c h o b i n g e rI n c i s i o n<br />
  44. 44. M o d i f i e d S c h o b i n g e r<br />I n c i s i o n<br />
  45. 45. Steps of Radical <br />Neck Dissection<br />

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